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Bachiocco V, Cappa M, Petroni A, Salsano E, Bizzarri C, Ceccarelli I, Cevenini G, Pensato V, Aloisi AM. Pain Study in X-Linked Adrenoleukodystrophy in Males and Females. Pain Ther 2021; 10:505-523. [PMID: 33609269 PMCID: PMC8119579 DOI: 10.1007/s40122-021-00245-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/08/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION X-linked adrenoleukodystrophy (ALD) is a metabolic disorder in which very long chain fatty acids (VLCFAs) are accumulated in the nervous system and adrenal cortex, impairing their functions. Three main variants are described in males: adrenomyeloneuropathy (AMN), a cerebral form (cALD or cAMN) and Addison's disease only (AD), while for females no classification is used. To evaluate pain and the functional state of afferent fibers, a series of tests was carried out in male and female patients. METHODS Chronic pain occurrence and sensory phenotype profile were assessed in 30 patients (20 male: 10 AMN, 1 cAMN, 1 cALD, 8 AD; and 10 female). A set of instruments assessed the intensity, quality and extent of pain, while a battery of quantitative sensory testing (QST) procedures examined the functional status of Aβ and Aδ fibers. Principal component analysis and hierarchical clustering with sensory responses input were used to identify distinct clusters. RESULTS Nearly half of the subjects reported pain, with a high prevalence in females and male AMN patients. No sex differences in pain dimensions were found. The sensory responses were heterogeneous, differing among the clinical variants and between genders. Male AMN/cAMN/cALD patients showed the worst impairment. Aβ and Aδ fibers were affected in males and females, but Aβ fibers appeared undamaged in females when tactile sensitivity was tested. Abnormal responses were localized in the lower body district, according to the dying-back pattern of the neuropathy. Cluster analysis showed discrete clusters for each function examined, with well-interpretable sensory and clinical phenotypes. CONCLUSION The study of pain and of the sensory profile appears to indicate a difference in the mechanisms underlying the AMN/cAMN/cALD and AD clinical forms and in the treatment of the respective generated pain types.
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Affiliation(s)
- Valeria Bachiocco
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco Cappa
- Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Petroni
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Biomedicine and Nutrition Research Network, Milan, Italy
| | - Ettore Salsano
- IRCCS C. Besta Neurological Institute Foundation, Milan, Italy
| | | | - Ilaria Ceccarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gabriele Cevenini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Viviana Pensato
- IRCCS C. Besta Neurological Institute Foundation, Milan, Italy
| | - Anna M Aloisi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
- Biomedicine and Nutrition Research Network, Milan, Italy.
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Yagüe S, Jucglà A, Povedano M, Lazo C, Veciana M. Laser evoked potentials in the evaluation of hypoesthetic patches in tuberculoid leprosy. Clin Neurophysiol 2020; 132:542-544. [PMID: 33450576 DOI: 10.1016/j.clinph.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Sara Yagüe
- Neurophysiology Unit, Neurology Department, Hospital Universitari de Bellvitge, Feixa Llarga, 08907 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Neurophysiology, Hospital Universitari Dexeus, Sabino Arana 5-19, 08028 Barcelona, Spain.
| | - Anna Jucglà
- Dermatology Unit, Hospital Universitari de Bellvitge, Feixa Llarga, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Mònica Povedano
- Neurophysiology Unit, Neurology Department, Hospital Universitari de Bellvitge, Feixa Llarga, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Claudia Lazo
- Neurophysiology Unit, Neurology Department, Hospital Universitari de Bellvitge, Feixa Llarga, 08907 L'Hospitalet de Llobregat, Barcelona, Spain; Neurophysiology Unit, Hospital Universitari Arnau de Vilanova, Av. Rovira Roure 80, 25198 Lleida, Spain.
| | - Misericordia Veciana
- Neurophysiology Unit, Neurology Department, Hospital Universitari de Bellvitge, Feixa Llarga, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
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Casasnovas C, Ruiz M, Schlüter A, Naudí A, Fourcade S, Veciana M, Castañer S, Albertí A, Bargalló N, Johnson M, Raymond GV, Fatemi A, Moser AB, Villarroya F, Portero-Otín M, Artuch R, Pamplona R, Pujol A. Biomarker Identification, Safety, and Efficacy of High-Dose Antioxidants for Adrenomyeloneuropathy: a Phase II Pilot Study. Neurotherapeutics 2019; 16:1167-1182. [PMID: 31077039 PMCID: PMC6985062 DOI: 10.1007/s13311-019-00735-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
X-Adrenoleukodystrophy (X-ALD) and its adult-onset, most prevalent variant adrenomyeloneuropathy (AMN) are caused by mutations in the peroxisomal transporter of the very long-chain fatty acid ABCD1. AMN patients classically present spastic paraparesis that can progress over decades, and a satisfactory treatment is currently lacking. Oxidative stress is an early culprit in X-ALD pathogenesis. A combination of antioxidants halts the clinical progression and axonal damage in a murine model of AMN, providing a strong rationale for clinical translation. In this phase II pilot, open-label study, 13 subjects with AMN were administered a high dose of α-tocopherol, N-acetylcysteine, and α-lipoic acid in combination. The primary outcome was the validation of a set of biomarkers for monitoring the biological effects of this and future treatments. Functional clinical scales, the 6-minute walk test (6MWT), electrophysiological studies, and cerebral MRI served as secondary outcomes. Most biomarkers of oxidative damage and inflammation were normalized upon treatment, indicating an interlinked redox and inflammatory homeostasis. Two of the inflammatory markers, MCP1 and 15-HETE, were predictive of the response to treatment. We also observed a significant decrease in central motor conduction time, together with an improvement or stabilization of the 6MWT in 8/10 subjects. This study provides a series of biomarkers that are useful to monitor redox and pro-inflammatory target engagement in future trials, together with candidate biomarkers that may serve for patient stratification and disease progression, which merit replication in future clinical trials. Moreover, the clinical results suggest a positive signal for extending these studies to phase III randomized, placebo-controlled, longer-term trials with the actual identified dose. ClinicalTrials.gov Identifier: NCT01495260.
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Affiliation(s)
- Carlos Casasnovas
- Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Feixa Llarga s/n, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
| | - Montserrat Ruiz
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
- Institute of Neuropathology, Bellvitge Biomedical Research Institute, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Agatha Schlüter
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
- Institute of Neuropathology, Bellvitge Biomedical Research Institute, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alba Naudí
- Biomedical Research Institute of Lleida, Montserrat Roig 2, 25008, Lleida, Spain
| | - Stéphane Fourcade
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
- Institute of Neuropathology, Bellvitge Biomedical Research Institute, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Misericordia Veciana
- Neurophysiology Unit, Neurology Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sara Castañer
- Centre Bellvitge, Institut de Diagnòstic per la Imatge, Feixa Llarga s/n, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonia Albertí
- Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Feixa Llarga s/n, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Bargalló
- Department of Neuroradiology, Hospital Clínic, Barcelona, Spain
- Magnetic Resonance Imaging Core Facility, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Johnson
- Deparment of Neurology and Pediatrics, University of Minnesota Medical Center, 516 Delaware Street Southeast, Minneapolis, Minnesota, 55455, USA
| | - Gerald V Raymond
- Deparment of Neurology and Pediatrics, University of Minnesota Medical Center, 516 Delaware Street Southeast, Minneapolis, Minnesota, 55455, USA
| | - Ali Fatemi
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205, USA
| | - Ann B Moser
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205, USA
| | - Francesc Villarroya
- Departament de Bioquimica i Biologia Molecular and Institute of Biomedicine of the University of Barcelona, Facultat de Biologia, Universitat de Barcelona, Avinguda Diagonal 645, 08028, Barcelona, Spain
- Center for Biomedical Research in Physiopathology of Obesity and Nutrition, Bellvitge Biomedical Research Institute, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
| | - Manuel Portero-Otín
- Biomedical Research Institute of Lleida, Montserrat Roig 2, 25008, Lleida, Spain
| | - Rafael Artuch
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Reinald Pamplona
- Biomedical Research Institute of Lleida, Montserrat Roig 2, 25008, Lleida, Spain
| | - Aurora Pujol
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute, Hospital Duran i Reynals, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.
- Center for Biomedical Research on Rare Diseases, Institute of Health Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain.
- Institute of Neuropathology, Bellvitge Biomedical Research Institute, Gran Via de l'Hospitalet 199, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.
- Catalan Institution of Research and Advanced Studies, Passeig de Lluís Companys 23, 08010, Barcelona, Spain.
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